Perkins Grant Chromebook Request Form
Please READ the following carefully:
•
A $25 cash deposit is required for the loan of a laptop.
• The laptop is the property of the Rochester EOC Perkins Grant and should only be used for appropriate educational activities as outlined by the Rochester EOC.
• The laptop should be protected from theft and/or damage.
• A laptop not working properly may be returned immediately to the Rochester EOC with explanation of the problem. A replacement may be re-issued.
• The laptop will be loaned only for the period of time a student is actively enrolled in an REOC program. The laptop will be returned upon program completion or immediately upon withdrawal, drop, suspension, termination (regardless of any retention plan in place for the purpose of returning to classes in the future).
• A laptop loan may be extended upon approval of the Perkins Grant Director.
• All data and/or files on the laptop should be removed and/or saved to a flash drive or other storage medium prior to returning it to the Rochester EOC.
• The $25 deposit becomes non-refundable if the laptop is not returned as expressed by the terms above or in a condition that renders it unusable or in need of significant financial repair as determined by REOC's Information Technology Department.
• I understand that any lost, damaged or stolen equipment/devices and/or accompanying accessories are my financial responsibility. I agree that if I fail to return the equipment, and/or if I fail to pay for repair/replacement of the equipment, I will forfeit my $25 deposit and a hold will be placed on my Rochester EOC student account. This hold will result in the denial of all Rochester EOC services, including transcript release, diploma release and registration privileges for the current and/or future terms.
Student's Name
Student's Name
*
First
Last
Student ID Number (located on Student ID or schedule)
Start with the letter "U" followed by 8 digits
Student's Address
Student's Address
*
Street Address
Address Line 2
City
State / Province / Region
Select a State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Postal / Zip Code
Country
United States
Student's Phone
Student's Phone
*
-
###
-
###
####
Student's Email
*
Program
*
Program
Barbering
Nursing Assistant (NA)
Child Development Associate (CDA)
Cosmetology
Culinary Arts
Practical Nurse (PN)
Medical Administrative Assistant
Pharmacy Technician
Sterile Processing Technician
Teacher Assistant
Emergency Telecommunications
Program Start Date
Program Start Date
*
/
MM
/
DD
YYYY
Program End Date
Program End Date
*
/
MM
/
DD
YYYY
Counselor's Name
Counselor's Name
*
First
Last
Submit